Epidural recordings of electrical events produced in the spinal cord by segmental, ascending and descending volleys

Epidural electrodes implanted for a percutaneous trial of therapeutic spinal cord stimulation were used to record electrical events evoked by the stimulation of peripheral nerves or of the spinal cord itself. The data collected in patients with no neurological deficit were analyzed in order (1) to check the consistency between epidural and surface recordings, (2) to get information on the genesis of such potentials, and (3) to demonstrate the feasibility of complex neurophysiological studies by means of epidural electrodes. Spinal cord potentials evoked by segmental volleys were recorded at cervical levels with the recording electrodes anterior, lateral and posterior to the spinal cord. The refractory period of the evoked potentials has been studied as well. Responses to stimulation of the tibial nerve were obtained at T11-12 vertebral level with posterior epidural electrodes. Segmental cervical potentials were characterized by a P10, N11, N13/P13 followed by a slow positivity/negativity. A response of similar waveform, but with different peak latencies, was recorded at segmental levels following tibial nerve stimulation. Such a response showed an increasing number of spikes while ascending along the spinal cord. Maximum conduction velocities in the cord were between 65 and 85 m/s. Our epidural recordings are similar to those obtained from the skin, but with a greater amplitude and waveform resolution. Furthermore, the use of epidural electrodes made it feasible to perform complex examinations of sensory function (i.e., the study of orthodromic and antidromic conduction along the dorsal cord and of the influence of a single dorsal cord volley on the segmental cervical potential). Finally, the genesis of the potentials recorded is discussed.     

Spinal cord evoked potentials and edema in the pathophysiology of rat spinal cord injury

Summary The possibility that nitric oxide is somehow involved in the early bioelectrical disturbances following spinal cord injury in relation to the later pathophysiology of the spinal cord was examined in a rat model of spinal cord trauma. A focal trauma to the rat spinal cord was produced by an incision of the right dorsal horn of the T 10–11 segments under urethane anaesthesia. The spinal cord evoked potentials (SCEP) were recorded using epidural electrodes placed over the T9 and T12 segments of the cord following supramaximal stimulation of the right tibial and sural nerves in the hind leg. Trauma to the spinal cord significantly attenuated the SCEP amplitude (about 60%) immediately after injury which persisted up to 1h. However, a significant increase in SCEP latency was seen at the end of 5h after trauma. These spinal cord segments exhibited profound upregulation of neuronal nitric oxide synthase (NOS) immunoreactivity, and the development of edema and cell injury. Pretreatment with a serotonin synthesis inhibitor drug p-chlorophenylalanine (p-CPA) or an anxiolytic drug diazepam significantly attenuated the decrease in SCEP amplitude, upregulation of NOS, edema and cell injury. On the other hand, no significant reduction in SCEP amplitude, NOS immunolabelling, edema or cell changes were seen after injury in rats pretreated with L-NAME. These observations suggest that nitric oxide is somehow involved in the early disturbances of SCEP and contribute to the later pathophysiology of spinal cord injury.     

伸长细胞移植对大鼠脊髓损伤后运动功能及运动诱发电位的影响

目的:研究伸长细胞是否可以促进成年大鼠脊髓损伤后传导束再生。方法:采用Wistar大鼠脊髓T8全横断模型,移植传代培养的伸长细胞,以未移植脊髓损伤组为对照,观察两组损伤后第12周末BBB评分,损伤平面以下红核-脊髓运动诱发电位,和横断部位组织学染色结果。结果:第12周末伸长细胞移植组红核脊髓运动诱发电位总峰值显著高于对照组(MD=133.2μV,P0.01),峰潜伏期较对照组缩短(MD=0.061ms,P=0.040);第12周末伸长细胞移植组BBB评分显著高于对照组(MD=5.0000,P0.01);第12周末脊髓横断部位HE染色显示伸长细胞移植组脊髓损伤处结构较完整。结论:伸长细胞移植可以促进大鼠脊髓损伤后神经传导的恢复。     

Refined sensory measures of neural repair in human spinal cord injury: bridging preclinical findings to clinical value

Sensory input from the periphery to the brain can be severely compromised or completely abolished after an injury to the spinal cord. Evidence from animal models suggests that endogenous repair processes in the spinal cord mediate extensive sprouting and that this might be further attenuated by targeted therapeutic interventions. However, the extent to which sprouting can contribute to spontaneous recovery after human spinal cord injury (SCI) remains largely unknown, in part because few measurement tools are available in order to non-invasively detect subtle changes in neurophysiology. The proposed application of segmental sensory evoked potentials (e.g., dermatomal contact heat evoked potentials and somatosensory evoked potentials) to assess conduction in ascending pathways (i.e., spinothalamic and dorsal column, respectively) differs from conventional approaches in that individual spinal segments adjacent to the level of lesion are examined. The adoption of these approaches into clinical research might provide improved resolution for measuring changes in sensory impairments and might determine the extent by which spontaneous recovery after SCI is mediated by similar endogenous repair mechanisms in humans as in animal models.     

Protective effect of vitamin E on spinal cord injury by compression and concurrent lipid peroxidation

Studies were made on the influence of vitamin E on the effects of compression injury of the spinal cord associated with ischemia in rats. The motor disturbance induced by spinal cord injury was greatly reduced by vitamin E supplementation. After injury, the spinal cord evoked potentials showed greater recovery of both amplitude and latency in the vitamin E-supplemented group than in the control group. Spinal cord blood flow was promptly restored and remained normal after injury in the vitamin E-supplemented group, but was significantly decreased from 3 h after injury in the control group. Thiobarbituric acid (TBA)—reactive substances in the spinal cord was immediately increased by compression injury in both groups, and after injury it persisted at a high value for 24 h in the control group, but decreased within 1 h in the vitamin E-supplemented group. Pathological examination of the spinal cord showed less damage, such as bleeding and edema, in the vitamin E-supplemented group than in the control group. Vitamin E may have protective effects on the spinal cord by inhibiting damage induced by lipid peroxidation and/or by sustaining the blood flow by maintaining the normal metabolism of arachidonic acid.     

Growth hormone attenuates alterations in spinal cord evoked potentials and cell injury following trauma to the rat spinal cord

The influence of exogenous rat growth hormone on spinal cord injury induced alterations in spinal cord evoked potentials (SCEP) and edema formation was examined in a rat model. Repeated topical application of rat growth hormone (20microl of 1microg/ml solution) applied 30min before injury and at 0min (at the time of injury), 10min, 30min, 60min, 120min, 180min, and 240min, resulted in a marked preservation of SCEP amplitude after injury. In addition, the treated traumatised cord showed significantly less edema and cell changes. These observations suggest that growth hormone has the capacity to improve spinal cord conduction and attenuate edema formation and cell injury in the cord indicating a potential therapeutic implication of this peptide in spinal cord injuries.     

Cortical reorganization in training.

Plasticity within the human central motor system occurs and has been studied with transcranial magnetic stimulation in patients with amputations, spinal cord injuries, and ischemic nerve block. These studies have identified a pattern of motor system reorganization that results in enlarged muscle representation areas and large motor evoked potentials (MEPs) for muscles immediately proximal to the lesion. Some of these changes are apparent minutes after ischemic nerve block, weeks after spinal cord injury, and as early as six months after amputation.These studies motivated us to study the cortical motor reorganization after finger movement training in normals and after anastomosis of intercostal nerves to the musculocutaneous nerve in young patients with cervical root avulsions due to a traumatic motorcycle injury.     

Optical Monitoring and Detection of Spinal Cord Ischemia

Spinal cord ischemia can lead to paralysis or paraparesis, but if detected early it may be amenable to treatment. Current methods use evoked potentials for detection of spinal cord ischemia, a decades old technology whose warning signs are indirect and significantly delayed from the onset of ischemia. Here we introduce and demonstrate a prototype fiber optic device that directly measures spinal cord blood flow and oxygenation. This technical advance in neurological monitoring promises a new standard of care for detection of spinal cord ischemia and the opportunity for early intervention. We demonstrate the probe in an adult Dorset sheep model. Both open and percutaneous approaches were evaluated during pharmacologic, physiological, and mechanical interventions designed to induce variations in spinal cord blood flow and oxygenation. The induced variations were rapidly and reproducibly detected, demonstrating direct measurement of spinal cord ischemia in real-time. In the future, this form of hemodynamic spinal cord diagnosis could significantly improve monitoring and management in a broad range of patients, including those undergoing thoracic and abdominal aortic revascularization, spine stabilization procedures for scoliosis and trauma, spinal cord tumor resection, and those requiring management of spinal cord injury in intensive care settings.     

大鼠脊髓诱发电位与脊髓损伤的关系——Ⅱ、皮肤、椎板和硬膜上诱发电位的比较

从大鼠的背侧皮肤表面和椎板分别记录刺激坐骨神经诱发的脊髓电位,并与硬膜上电位进行了比较。结果表明:皮肤表面电位与硬膜上直接记录具有相同的节段性特征。从硬膜上经椎板至皮肤表面、反应潜伏时延长、电位幅度递减。各波峰潜伏时也相应增加。电位的波形、幅度与记录方式有关,但反应潜伏时不受影响。     

Topical application of dynorphin A (1-17) antiserum attenuates trauma induced alterations in spinal cord evoked potentials,microvascular permeability disturbances,edema formation and cell injury: an experimental study in the rat using electrophysiological and morphological approaches

Summary.  Dynorphin is a neuropeptide that is present in high quantities in the dorsal horn of the spinal cord. The peptide is actively involved in pain processing pathways. However, its involvement in spinal cord injury is not well known. Alteration in dynorphin immunoreactivity occurs following a focal trauma to the rat spinal cord. Infusion of dynorphin into the intrathecal space of the cord results in ischemia, cell damage and abnormal motor function. Antibodies to dynorphin when injected into the intrathecal space of the spinal cord following trauma improve motor recovery, reduce edema and cell changes. However, influence of dynorphin on trauma induced alteration in spinal cord bioelectrical activity is still not known. Spinal cord evoked potentials (SCEP) are good indicator of spinal cord pathology following trauma. Therefore, in present investigation, influence of dynorphin antibodies on trauma induced changes in SCEP were examined in our rat model. In addition, spinal cord edema formation, microvascular permeability disturbances and cell injury were also investigated. Our results show that topical application of dynorphin antiserum (1 : 200) two min before injury markedly attenuated the SCEP changes immediately after injury. In the antiserum treated animals, a significant reduction in the microvascular permeability, edema formation and cell injury was observed in the traumatised spinal cord. These observations suggest that (i) dynorphin is involved in the altered bioelectrical activity of the spinal cord following trauma, (ii) the peptide actively participates in the pathophysiological processes of cell injury in the spinal cord trauma, and (iii) the dynorphin antiserum has potential therapeutic value for the treatment of spinal cord injuries. Received July 3, 2001 Accepted August 6, 2001 Published online July 31, 2002     

Effect of leucine-enkephalin on the interneuronal transmission of excitation]

In the experiments on non-anesthetized flaxedil-immobilized cats it has been shown that the injection of leucin-enkephalin (1 mg) into the lateral ventricle of the brain is followed by the inhibition of evoked potentials in the ventrolateral columns of the spinal cord and of segmental interneuronal transmission in the spinal cord as well as by the reduction of the amplitude of potentials in the S I zone of the brain cortex induced by the sciatic nerve stimulation. Naloxone (1 mg/kg, i.v.) prevented the effects of leucin-enkephalin. Methysergide pretreatment (2.5 mg/kg, i.p.) led to a decrease of leucin-enkephalin effect on the interneuronal transmission in the spinal cord. Leucin-enkephalin failed to change the amplitude of polysynaptic potentials of glosso-mandibular reflex integrated at the brain stem level.     

大鼠脊髓诱发电位与脊髓损伤的关系——Ⅲ.脊髓局部损毁后电位的变化及电位来源分析

本文描述了大鼠脊髓L_1节段后柱、后索、侧索和前角的诱发电位及其损伤后的变化,并观察了切断L_4、L_5脊神经背、腹根与横断高位颈髓对电位的影响,以进行行电位来源分析。结果可见,上述四个区域的诱发电位基本由早反应三相波和晚反应组成。分别电解损毁这些部位后,电位波幅均普遍降低,晚期反应较早反应降低明显。后柱或后索受损对电位影响最大。局部损毁后可见L_1及T_(13)水平的硬膜上电位改变明显,尤其晚反应减弱、波峰平坦。反应时值与潜伏时未见明显改变。切断L_4脊神经背、腹根后、电位基本消失。去大脑对电位未见明显影响。结果表明,刺激坐骨神经诱发的脊髓电位起源于低位腰段传入神经和脊髓内多通路的兴奋传导,在一定程度上受腹根逆行活动的影响,与大脑及脊髓下行传导束活动无直接联系。脊髓诱发电位的幅度与波形改变可作为脊髓损伤的判断指标之一。     

急性脊髓损伤后大鼠电刺激运动诱发电位的变化

目的：比较不同程度脊髓损伤（SCI）与运动诱发电位（MEP）变化之间的关系,探索MEP检查在SCI早期诊断及预后中的价值。方法：27只雄性SD大鼠以改良Allen‘s打击法致伤T8－T9脊髓,按打击冲量随机分为空白对照组（n=5),SCI A组（50gcf,n=8),SCI B组（70gcf,n=8)和SCI C组（100gcf,n=6),采用单极经皮层电刺激,分别于损伤前、伤后即刻、15min、30min、1h、3h和6h连续观察scMEP变化,并计算脊髓出血坏死区域占脊髓横截面积的比率。结果：对照组MEP无显著改变,SCI A组和SCI B组动物MEP早成份波幅立即减低或消失,以后有所恢复,晚成份波消失后未再出现。SCI C组动物除2只大鼠SCI后MEP仍有所恢复外,其余动物再未出现MEP波。脊髓损伤随打击冲量增大而增加,与伤后1h scMEP最大波幅呈显著相关（r=-0.821)。结论：SCI后scMEP的变化程度与打击冲量和脊髓病理损伤面积相关,提示scMEP可以作为一种脊髓功能检测的客观指标。     

Somatosensory cerebral potentials evoke by stimulation of the lumbo-sacral spinal cord in normal subjects and in patients with conus medullaris and cauda equina lesions

Somatosensory cerebral evoked potentials were recorded by intrathecal stimulation of the lumbo-sacral cord and roots in 16 normal subjects and patients having cauda/conus injury (group A, 15 cases), compressive lesions of cauda equina (group B, 13 cases) and lesions of both types covering the lumbar cord (group C, 24 cases). The shape of the intrathecally evoked cerebral potential (IECP) was basically the same as that obtained by posterior tibial nerve stimulation from 12 normal subjects except that the early components were 10–15 msec shorter in latency in the former potential, with an average of 12 msec.IECPs were easily recorded in groups A and B, but a significant delay was found in both groups, especially group A. It was difficult to obtain the IECP in group C, When it could be recorded the latency increase was apparent. These findings were explained on the basis of degeneration of the ascending spinal nerve fibers proximal to the lesion site.     

Botulinum toxin A inhibits ATP release from bladder urothelium after chronic spinal cord injury

The effects of mechanoreceptor stimulation and subsequent ATP release in spinal cord injured and normal bladders was examined to demonstrate if spinal cord injury (SCI) modulates the basal or evoked release of ATP from bladder urothelium and whether intravesical botulinum toxin A (BTX-A) administration inhibits urothelial ATP release, a measure of sensory nerve activation. A Ussing chamber was used to isolate and separately measure resting and mechanoreceptor evoked (e.g. hypoosmotic stimulation) ATP release from urothelial and serosal sides of the bladder. Following spinal cord injury, resting urothelial release of ATP was ninefold higher than that of normal rats. Botulinum toxin A instillation did not significantly affect the resting release of ATP after spinal cord injury. Evoked ATP release following hypoosmotic stimulation was significantly higher in chronic spinal cord injured compared to normal rat bladders. However, botulinum toxin A treatment markedly reduced ATP release in spinal cord injured bladders by 53% suggesting that ATP release by mechanoreceptor stimulation, as opposed to basal release, occurs by exocytotic mechanisms. In contrast, there was no significant difference in basal or evoked ATP release from bladder serosa following spinal cord injury. Moreover, intravesical instillation of botulinum toxin A did not affect ATP release from the serosal side after spinal cord injury, suggesting that its effects were confined to the urothelial side of the bladder preparation. In summary: (1) increased release of ATP from the urothelium of spinal cord injured bladders may contribute to the development of bladder hyperactivity and, (2) mechanoreceptor stimulated vesicular ATP release, as opposed to basal non-vesicular release of ATP, is significantly inhibited in spinal cord injured bladders by intravesical instillation of botulinum toxin A. These results may have important relevance in our understanding of the mechanisms underlying plasticity of bladder afferent pathways following SCI.     

Aberrant Crossed Corticospinal Facilitation in Muscles Distant from a Spinal Cord Injury

Crossed facilitatory interactions in the corticospinal pathway are impaired in humans with chronic incomplete spinal cord injury (SCI). The extent to which crossed facilitation is affected in muscles above and below the injury remains unknown. To address this question we tested 51 patients with neurological injuries between C2-T12 and 17 age-matched healthy controls. Using transcranial magnetic stimulation we elicited motor evoked potentials (MEPs) in the resting first dorsal interosseous, biceps brachii, and tibialis anterior muscles when the contralateral side remained at rest or performed 70% of maximal voluntary contraction (MVC) into index finger abduction, elbow flexion, and ankle dorsiflexion, respectively. By testing MEPs in muscles with motoneurons located at different spinal cord segments we were able to relate the neurological level of injury to be above, at, or below the location of the motoneurons of the muscle tested. We demonstrate that in patients the size of MEPs was increased to a similar extent as in controls in muscles above the injury during 70% of MVC compared to rest. MEPs remained unchanged in muscles at and within 5 segments below the injury during 70% of MVC compared to rest. However, in muscles beyond 5 segments below the injury the size of MEPs increased similar to controls and was aberrantly high, 2-fold above controls, in muscles distant (>15 segments) from the injury. These aberrantly large MEPs were accompanied by larger F-wave amplitudes compared to controls. Thus, our findings support the view that corticospinal degeneration does not spread rostral to the lesion, and highlights the potential of caudal regions distant from an injury to facilitate residual corticospinal output after SCI.     

Electrophysiological Analysis of Transmission Via Spinal Pathways After Vertebral Trauma

Complex electrophysiological examination of the state of spinal neuronal mechanisms was carried out in patients after complicated vertebral trauma (n = 52). Electromyographic responses of the muscles of the upper and lower limbs evoked by stimulation of the peripheral nerves, effects of magnetic stimulation (MS) of the brain cortex (transcranial MS, TMS) and spinal roots, and somatosensory evoked potentials (SSEPs) were recorded. Partial disorders of the motor functions of the lower limbs were observed in 21 patients. Subjects with complete absence of movements of the limbs demonstrated two variants of the patterns of electrophysiological phenomena. In 21 patients, evoked potentials were entirely absent, while reduced MS-evoked motor responses (MS MRs) and SSEPs could be observed in 10 subjects. The presence of these potentials was indicative of partial preservation of the cerebrospinal pathways after damage to the spinal cord. Thus, estimation of the results of complex electrophysiological examination allows one to objectively verify the state and dynamics of transmission via the spinal pathways, to make justified the tactics of treatment, and to estimate the efficacy of the measures directed toward recovery of the lost functions of spinal mechanisms.     

A presynaptic locus of the action of Met-enkephalin demonstrated in mouse spinal cord cultures

Monosynaptic excitatory post-synaptic potentials (EPSPs) evoked in spinal cord (SC) neurons by stimulation of dorsal root ganglion (DRG) neurons in cell cultures were reduced by perfusion application of the opiate peptide, Met-enkephalin (2-4 microM). In about 2/3 of cases examined, EPSPs evoked by stimulation of spinal cord cells were also reduced by Met-enkephalin. The effects were antagonized by concomitant perfusion with naloxone (1-2 microM) and recovered when perfusion with Met-enkephalin was stopped. Statistical analysis of synaptic responses indicated that the reduction of EPSP amplitude was due, at least to a major extent, to a decrease in presynaptic transmitter release.     

正常小儿胫神经诱发脊髓电位特征和脑瘫小儿该电位的变化

采取刺激后胫神经(PTN)诱发叠加技术,利用体表无创伤性双极记录方法观察了16例正常小儿和43例脑瘫小儿的脊髓诱发电位(SCEP)。正常小儿的SCEP自下而上潜伏时逐渐延长、电压减小。从椎体C6到T10表现为Pa-Na-Pb三相波,T10～T12为Pa-Na1-Na2-Pb波,T12～L4为多相复合波。左右侧SCEP波形相似,潜伏时、电压相同,它们之间无统计学显著差别;但不同节段之间SCEP差异显著;脊髓传导速度为57.14m/s。脑瘫小儿SCEP正常者占14％;全髓反应低下者占20％;左右侧反应不对称者占46％;节段性反应低下者占15％;其它异常约占5％。不但节段间存在显著差异,而且全脊髓左右侧电压间以及颈、腰骶髓的潜伏时间出现显著差异。脊髓传导速度减低(患侧46.22m/s,对侧53.48m/s)。结果提示:(1)正常小儿脊髓活动左右对称,不同脊髓节段对PTN刺激反应不同。(2)脑瘫小儿脊髓活动左右不对称,一侧功能下降时对侧有一定代偿力,脊髓传导速度减慢。